Jae-Yoon Shim

Massive perivillous fibrin deposition in the placenta and uterine metastasis of gastric adenocarcinoma during pregnancy.

The prognosis of gastric cancer during pregnancy is unfavorable because of delayed diagnosis and advanced stage. We present a case of gastric carcinoma metastasized to the placenta and uterus during pregnancy. Pathological examination revealed a poorly differentiated adenocarcinoma of the stomach with lymph node metastasis. After counseling, the patient decided to terminate the pregnancy and begin immediate treatment for gastric cancer. Hysterectomy and subtotal hysterectomy were performed because medical termination of the pregnancy was unsuccessful. Pathological examination of the placenta and uterus revealed metastases of gastric adenocarcinoma. All the uterine vessels were packed with tumor cells and the myometrium showed extensive coagulative necrosis. Moreover, microscopic findings of the placenta were consistent with massive perivillous fibrin deposition. Our case clearly suggests that massive perivillous fibrin deposition in the placenta can be associated with malignancy during pregnancy and that uterine metastasis of maternal malignancy may result in myometrial dysfunction unresponsive to uterotonics.

P28.02: Three-dimensional sonographic measurements of placental volume at early pregnancy

growth discordance. Amniocentesis on the normal twin showed a normal 46,XX karyotype. As pregnancy progressed the fetus with the cystic hygroma developed progressive hydrops with dramatic skin edema. The diagnosis of TRAP was suspected but could not be proven as the direction of flow in the umbilical artery could not be determined with confidence. In addition, there was persistent cardiac activity. At delivery, examination of the fetus and placenta confirmed TRAP sequence. TRAP sequence is a rare complication of twinning, occurring in approximately 1% of monochorionic gestations, or 1/35 000 births. The most common presentation is a grossly anomalous twin with no heart beat and reversed umbilical arterial flow. It is often mistaken for a twin gestation with an early demise. There are case reports of TRAP sequence presenting with initial cardiac activity in both fetuses. This case is unusual in that cardiac activity was present in the TRAP fetus throughout the 26 weeks of gestation. The pregnancy management would have been altered if the diagnosis could have been confirmed earlier. In MCDA pregnancies with an apparent anomalous twin, the direction of flow in the umbilical cord should be established as early as possible in order to diagnose TRAP sequence at the earliest opportunity.

Diffuse decidual leucocytoclastic necrosis and NK cell aggregates: two distinct features of miscarriage

Aims Primary histopathology of miscarriage remains undetermined in the majority of cases. This study was conducted to determine histological characteristics pertinent to miscarriage. Methods The study groups were composed of elective abortions (n=29) and miscarriages (n=45) comprised of chromosomally normal (n=15) and abnormal cases (n=30). Immunohistochemistry was done against CD3, CD8, TIA-1 and CD56. Results Two histological features—diffuse decidual leucocytoclastic necrosis (DDLN) and decidual natural killer cell aggregates (NKCA)—were relatively common in miscarriages. The frequencies of DDLN and NKCA were different between the groups (p<0.05 and p<0.05, respectively). DDLN was found in 13.8% (4/29) of elective abortions, while it was observed in 60.0% (9/15) and 23.3% (7/30) of chromosomally normal and abnormal miscarriages, respectively. DDLN was more frequent in chromosomally normal miscarriages than in elective abortions (p=0.004). NKCA was present in 13.8% (4/29) of elective abortions, while being found in 33.3% (5/15) and 43.3% (13/30) of chromosomally normal and abnormal miscarriages, respectively. NKCA was more frequent in chromosomally abnormal miscarriages than in elective abortions (p=0.020). Conclusions The findings strongly suggest that defective placentation and abnormal maternal immune response are associated with miscarriage. DDLN and NKCA seem to have diagnostic values in the pathological evaluation of miscarriage.

OP03.11: Normal fetal lung volume using three-dimensional eXtended Imaging Virtual Organ Computer aided AnaLysis (XIVOCAL) method in Korean population

the left lung, and R2 = 0,937 to the total lung volume). The lung volume also proved to be highly related to fetal weight (R2 = 0,905 to the right lung, R2= 0,84to the left lung, and R2 = 0,908 to the total lung volume). The intra-observer variability study was of 0,990 for the right lung, 0,986 for the left lung, and 0,995 for the total lung volume. The value of Cronbach Alfa Coefficient to evaluate the inter-observer variability was 0,975 for the right lung, and 0,962 for the left lung. Conclusion: the fetal lung volume measurement by VOCAL method of 3-dimensional unltrasonography shows good reproducibility and can be utilized to evaluate fetal lung growth.

OC12.01: Prenatal counseling of fetal lymphangioma except nuchal lesion

Aim: There are few data about endometrial thickness measurement with fluid contrast ultrasound. The threshold value that is correlated to an increased risk of histologic abnormalities might be different for the sum of single-layer measurements at contrast ultrasound in comparison to the double-layer measurement with conventional transvaginal ultrasonography (Ultrasound Obstet Gynecol 2000; 16:254–9; Obstet Gynecol 2000; 95:95–103). The aim of this study was to compare the ultrasound measurements for endometrial thickness before and after fluid instillation. Methods: Observational study on 843 consecutive patients presenting at the ‘‘one stop bleeding clinic’’ of the University Hospital Leuven. All patients underwent first an unenhanced ultrasonography (UUS): the total (double layer) endometrial thickness (ET) was measured at its thickest part in the sagittal plane. Thereafter the same patients underwent a fluid contrast sonography (CSH) (saline infusion in 402 and gel infusion in 441): both layers were measured and the sum was recorded. The endometrial thicknesses before and after fluid instillation were compared. Results: The mean patients’ age was 50.5 year (SD 11.7). The technical failure rate for CSH was 3.1%. The endometrium was not recorded in 9.5% at UUS versus in 2.5% at CSH. The mean ET was 9.4mm (SD 6.7; range 1.1-49) at UUS versus 9.1mm (SD 6.2; range 1.2-78) at CSH. Endometrial thickness was obtained on both UUS and CSH in a total of 730 patients. The correlation coefficient for ET between UUS and CSH was 0.89. In 375 (51.4%) a thicker ET was measured at UUS as compared with CSH, in 338 (46.3%) a thinner. Conclusion: Our data showed a good correlation for endometrial thickness measurement with and without fluid contrast ultrasound. This suggests that the current guidelines for endometrial thickness used for detecting endometrial abnormalities may be applied for CSH.

P32.05: Prenatal echocardiography of total anomalous pulmonary venous connection (TAPVC) : isolated or accompanied by pulmonary venous stenosis

RAA with mirror-image branching. Only one case had deletion of chromosome 22q11. In this case, omphalocele was also found. In two of the cases of RAA with mirror-image branching, the parents chose to terminate the pregnancy. One case of RAA with mirrorimage branching was born alive and received corrective surgery for TOF. In the case of RAA with an aberrant left subclavian artery, no other associated anomalies were recognized despite the vascular ring being formed in the prenatal period. This case was born alive and did well with spontaneous closure of the ductus arteriosus. Conclusion: Prenatal detection of RAA is feasible by 3 VT view. RAA combined with TOF is very common in RAA with mirror-image branching. Meticulous cardiac and extra-cardiac examination with invasive testing seems to be mandatory in prenatal diagnosis of RAA.

P02.11: The outcome of fetal isolated pleural effusion

accuracy of prenatal diagnosis at our center is 73.2% (205/280). The four most accurate systems are abdominal wall (accuracy: 100%), hydrops fetalis (100%), thorax (100%), and gastrointestinal (82.2%) system. The four most inaccurate systems are heart (49%), musculoskeletal (66.7%), face and neck (70.8%), and neural axis (73.5%) system. The differences of accuracy in each system are statistically significant (p < 0.01). Conclusions: Our results show that the accuracy of ultrasound for detecting fetal anomaly differs according to fetal anatomical system. To improve the accuracy system oriented training program for fetal ultrasound is needed.